Musculoskeletal Notes From RSNA 1999
Written by Joseph A. Gagliardi, M.D..
Clearly, the RSNA is one of the largest medical meetings in the world, with nearly 60,000 attendees. There is no other radiological meeting which draws such large numbers of physicians and researchers to one venue in order to publish and present ideas and conclusions from investigative pursuits. Unfortunately, this attribute also has a down side, as it makes it impossible to review every oral scientific presentation, poster display, computer file and review lecture in a particular subspecialty. My apologies to those outstanding educational presentations that I was unable to attend.
Poster Section
There was a multitude of impressive international poster displays. When I visit this section my main goal is to find interesting and detailed review topics. As I have had the pleasure to attend many of the prior RSNA and Roentgen Ray meetings, I have found that certain authors routinely present terrific reviews; and if I see these authors' names on a poster I always stop and read them carefully. (Without a doubt, if any poster has Javier Beltran's, Donald Resnick's, Mark Murphy's or Elliot Fishman's names on it it warrants close attention.)
This year there were many posters evaluating the role ultrasound plays in evaluating musculoskeletal pathology, especially for tendon abnormalities. Favorable data were presented depicting the value ultrasound has, especially with power Doppler, in examining tendons such as the Achilles (Italy), biceps (Italy), patella (Ireland), and rotator cuff (Taiwan). Two generalized reviews of tendons and tendon pathology were also submitted from Spain and Italy. Soft tissue sonography evaluations of nerves (Italy, Korea and Spain) as well as disc evaluation (Japan) were also presented. There was an excellent interactive tutorial on musculoskeletal sonography submitted from the University of Michigan, which can be accessed at http://www.med.umich.edu/rad/muscskel/mskus/. Furthermore there was a series of oral presentations as well as an afternoon special focus session dedicated to musculoskeletal ultrasound, which was especially thought provoking. The entire auditorium was filled to capacity, with people standing in the aisles and in the back. As the resolution of ultrasound improves, and with newer high-frequency transducers available, it appears that ultrasound is challenging MRI in its ability to accurately detect and stage certain ligament and tendon injuries. Although all agree a learning curve is needed, both physicians and, ultimately, ultrasound technologists need to learn these procedures which are reported to take as little as 15-20 minutes (e.g., for shoulder evaluation). Ultrasound is also being advocated for evaluation of loose bodies, soft tissue foreign bodies, orthopedic hardware complications, fluid and mass evaluation, as well as for possible fracture detection. I am not sure where all this will go and what will define the role of sonography in the near future. However, the presentations where quite thought provoking.
Oral Presentations
Ward et al (abstract 54) evaluated bone bruise detection using STIR and DW sequences and, in their experience, found the STIR sequences superior. Merl et al (abstract 55) reported that absorbable Poly-L-Lactid acid interference screws for ACL reconstruction may not be as absorbable as claimed. Jordan et al (abstract 56) reminded all to take care and not diagnose ACL tears when fluid is present in the ACL, as this finding could represent a cyst. Kaplan et al (abstract 58) smartly demonstrated that increased signal in the proximal or mid portions of the PCL can be related to magic angle and that evaluation with higher T-2 weighted pulse sequences should be compared. Magee et al (abstract 460) presented 10 surgically proved cases in which paralabral cysts in the hip were associated with labral tears, an important finding as labral tears can lead to arthritis. Following discussion revealed that 8 additional patients refused surgery. These researchers also had an excellent poster display on the same subject.
Math et al (abstract 992) and Spitalny and Sanford (abstract 1001) nicely reviewed findings in patients with jumper's knee and cuboid bone fractures, respectively. Jelly et al (abstract 995) found that CT is not particularly helpful in detecting clinically relevant cervical thoracic junction bone findings in polytraumatized intubated patients in which plain films appear normal. Anzilotti et al (abstract 997) found that abdominal CT scans obtained in trauma patients accurately detected lumbar spine fractures better than plain films and, in fact, plain film radiographs actually resulted in a few false positives resulting in additional work-up. Magee et al (abstract 1555) found that fluid in the subcutaneous tissues on knee MRI may be related to shearing injuries resulting in patient complaints and that when no intraarticular pathology is diagnosed at MRI conservative management, rather than arthroscopy, resulted in resolution of patient symptoms.
Categorical Course
My clinical duties not only include musculoskeletal imaging but also a great deal of body and genitourinary MRI. Although this may prejudice my views, the Categorical Course in Body MRI (Course No. 102) was, in my opinion, one of the best courses in recent history at the RSNA or any other meeting. All the lectures were excellent, both in slide presentation and content. Dr. McCarthy and the rest of the staff should be proud to have been associated with such an excellent course. For all musculoskeletal, genitourinary and body imagers out there I strongly recommend purchasing the syllabus.
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